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The Journal of Clinical Endocrinology & Metabolism Vol. 82, No. 8 2386-2390
Copyright © 1997 by The Endocrine Society

Reproductive Endocrinology

Long-Term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men

Hermann M. Behre, Sabine Kliesch, Eckhard Leifke, Thomas M. Link and Eberhard Nieschlag

Institute of Reproductive Medicine (H.M.B., S.K., E.L., E.N.) and Institute of Clinical Radiology (T.M.L.) of the University, Münster, Germany

Address all correspondence and requests for reprints to: Prof. Dr. E. Nieschlag, Institute of Reproductive Medicine of the University, Domagkstraße 11, D-48129 Münster, Germany. E-mail: nieschl{at}uni-muenster.de

In both men and women, a decrease in bone mineral density (BMD) is a major symptom of hypogonadism. Although the effects of estrogens on osteoporosis in women are well documented, comparatively little is known about the effects of long term testosterone substitution on BMD in hypogonadal men. Therefore, we studied BMD in 72 hypogonadal patients (37 men with primary and 35 men with secondary hypogonadism) under testosterone substitution therapy that continued for up to 16 yr. Thirty-two of these men were also seen before initiation of therapy. At annual intervals, trabecular BMD of the lumbar spine was measured by quantitative computed tomography, a true volumetric and reproducible method for long term serial BMD measurements. Serum levels of testosterone increased to the normal range in all androgen-treated hypogonadal men. The most significant increase in BMD was seen during the first year of testosterone treatment in previously untreated patients, when BMD increased from 95.2 ± 5.9 to 120.0 ± 6.1 mg/cm3 hydroxyapatite (mean ± SE). Long term testosterone treatment maintained BMD in the age-dependent reference range in all 72 hypogonadal men, independent of the type of hypogonadism. Transdermal testosterone patches applied to the scrotum were as effective in normalizing BMD as im testosterone enanthate injections. In summary, testosterone therapy increases BMD in hypogonadal men regardless of age. The greatest increase is seen during the first year of treatment in previously untreated patients with low initial BMD. In hypogonadal men, BMD can be normalized and maintained in the normal range by continuous, long term testosterone substitution.




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